United States -- The threat of malpractice. How much does it contribute...?

[khalid]

...to MDs "herding" into prescribing the same diagnosis, treatment and particularly medication?

I am thinking particularly of psychiatry, but perhaps this phenomenon happens in other medical areas?

As a patient and a 20-year attendee at AA meetings where many are prescribed psycho-active medications, over the years I have seen the usual diagnosis and prescribed drugs change, an pretty much in unison. Lets see. First it was Valium Then, "clinical depression", with Xanax being the 'sober' drug of choice -- and often abuse, followed by Prozac and the other SSRI's. The there was ADD, with Ritalin or other stimulants. I'm surprised to hear so many people regularly take Klonopin, not to mention percoset and other powerful pain medications. There are even "Pain Clinics" which advertise "On-site Dispensing" in display ads in our local weekly , right next to the "Massage" ads. And of course California's "Madical Marijuana Dispensaries".

During the last couple of years, AA meetings sprouted a a preponderance of "Bi-Polar Disorder". I've met a few people in my life who were undoubtedly Bi-Polar, but these days the unmistakable manic aspect of the illness seems to be singularly lacking in most of the people who have been given that diagnosis, both in their current behavior and the stories they relate about their lives in the course of AA meetings. Instead, what we get (and something I recognized because of the effect SSRI's had on my own cognition), is amorphous stream-of-consciousness monologues that I would call a direct side-effect of those medications.

What occurs to me is that in these relatively innocuous cases, as well as those who have suffered more serious and even catastrophic results of psychiatrist's common diagnosis and prescription -- what we may be seeing (beyond the encouragement of the drug companies) is US doctors' reticence to attempt to individualize diagnosis and treatment for fear that they might be singled out for malpractice suits. Something akin to the difficulty people describe in finding doctors who are willing to deliver babies in the USA today.

Your thoughts and input, particularly from experience?

[chozai65]

With the recent death of Michael Jackson, and last year’s death of Heath Ledger, both due to prescription drugs, more and more patients are examining their pill bottles and wondering what their future holds. Physicians are so quick to write prescriptions for anti-depressants, painkillers, sleeping pills and tranquilizers. Do we really need these toxic chemicals in our bodies? And what happens if we combine medications like sleeping pills and painkillers? Are we playing Russian roulette with pills?

The most commonly used painkiller in the US is acetaminophen (brand name Tylenol). This is easily available over the counter. Acetaminophen is also in sleep aids (for instance, Tylenol-PM), and in strong prescription narcotic painkillers such as Vicodin and Percocet. Recent studies have found that acetaminophen is the leading cause of liver damage and probably is responsible for 1600 cases of acute liver failure that occur each year. The drug is thought to be safe at the recommended dose but because it is in so many different kinds of medication, people often end up taking double or even triple doses if they are using different painkillers or sleep aids. An FDA advisory panel urged the FDA to ban Percocet and Vicodin and other prescription drugs that contain acetaminophen. Due to the amount of money made by pharmaceutical companies by the sales of narcotic medications, and the fact they spend about $150 million per year lobbying our government officials, it will be a long time before any real changes take place.

In 1998, the Journal of the American Medical Association published a study that stated that prescription medications were the fourth leading cause of death in America. Another study reported that there were 106,000 deaths per year from non-error, adverse effects of medications. And are you ready for the really scary part of this (as if that was not enough) – 2.2 million Americans per year are injured significantly by prescribed medications ending up with serious reactions and even with permanent disability. Not from accidental or intentional overdose, just from taking the prescribed dose.

Here is another scary fact: more than half of the experts hired to advise our government on the safety and efficacy of prescription medications have a financial interest or relationship with the pharmaceutical companies that will benefit by their decisions. Can you guess what advice they will give when they own stock in a “wonder drug” that may have problems or require more testing before it is released?

Here is some information from an article by Peter Breggin in Psychology Today in July 1994 (hope you are sitting down because this is almost unbelievable):

“Contrary to widespread public belief, the FDA does not conduct any of the studies used for drug approval; they are financed, constructed, and supervised by drug companies using doctors they hire. While it may take a decade for a drug to get through the FDA bureaucracy, the actual controlled scientific studies last–as in the case of Prozac–just four to six weeks. Anecdotal material is collected on longer-term patients, but for Prozac, only 63 patients were followed for more than two years before the drug’s approval.

For starters, seriously suicidal patients and hospitalized patients were excluded. Of the included patients, many were allowed to take sedatives and minor tranquilizers to overcome Prozac’s stimulant-like side effects, vastly compromising data interpretation.

After weeding out the most badly flawed studies, the FDA found only four that were adequate enough to consider. One of these showed that Prozac was no better than placebo. Three others supposedly showed Prozac to be somewhat superior to the sugar pill, but not as good as older antidepressants. However, due to adverse drug effects and lack of drug effectiveness, the dropout rates in most of these studies was very high.

While the gross number of patients receiving Prozac in all the trials was more than 5,000, the actual number finishing the trials used for approval was very small. When I counted the actual number of patients who completed the four- to six-week trials used for the approval of Prozac, it turned out to be a grand total of 286. It bears restating–only 286 patients finished the four- to six-week trials used to determine Prozac’s efficacy.

Because of the high dropout rates and because Prozac was often no better than placebo in many trials, many statistical maneuvers were required to make the studies look positive. In one of the key studies, involving six different sites around the country, results at five sites showed Prozac to have no benefit. One site–representing 25 percent of the patients who finished the trials–was discarded. Then the data from the remaining sites were pooled. This is such a scientifically unacceptable practice that the FDA prohibits drug companies from doing it in the studies used to support advertising claims. Yet the FDA allowed it

[talbot]

Great answer from Santa Ana! I wish more people would see it!
Titou- stay away from bus drivers!

[darrell]

It was amazing. Not knowing I had a broken ankle, my main concern was that the bus driver would lose his job. I thought he hadn't stopped because he didn't know he'd hit me. A driver who had seen him take off blocked him at the next stop. I limped up and said, "Listen, I know how you feel."...

[cleirach70]

His response (refusing my extended hand): "You know how I feel? Don't look like to me you got no Black children at home."

[banys]

His response (refusing my extended hand): "You know how I feel? Don't look like to me you got no Black children at home."

Titou- Santa Ana is right on!. I could add another 10 pages of examples of FDA-pharmaceutical corruption.

From what legitimate research I've seen, most antidepressant medications are only suitable for mild to moderate cases and are rarely of long lasting benefit without therapy.

No doubt, much perscribing is influenced by the threat of malpractice- particularly when it comes to testing (e.g., ekgs,pet scans, mri/s, eegs, cat scans, sonigrams, etc.). You could have pancreatic cancer and two days to live and be sent for a full MRI workup!

As importantly, doctors lose a ton of money money and "perks" from the pharmaceuticals if they don't push their brand of poison".

I know it sounds harsh, but its more true then not.